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Primary Care Interventions for Prevention and Cessation of Tobacco Use
in Children and Adolescents
US Preventive Services Task Force Recommendation Statement
US Preventive Services Task Force

Summary of Recommendations

The USPSTF recommends that primary care clinicians provide interventions, including education or
brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents. B

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of primary care–feasible interventions for the cessation of tobacco use among school-aged
children and adolescents.

I

See the Figure for a more detailed summary of the recommendation for clinicians. See the Practice Considerations section for more information on effective
interventions to prevent initiation of tobacco use and for suggestions for practice regarding the I statement. USPSTF indicates US Preventive Services Task Force.

IMPORTANCE Tobacco use is the leading cause of preventable death in the US. An estimated
annual 480 000 deaths are attributable to tobacco use in adults, including from secondhand
smoke. It is estimated that every day about 1600 youth aged 12 to 17 years smoke their first
cigarette and that about 5.6 million adolescents alive today will die prematurely from a
smoking-related illness. Although conventional cigarette use has gradually declined among
children in the US since the late 1990s, tobacco use via electronic cigarettes (e-cigarettes) is
quickly rising and is now more common among youth than cigarette smoking. e-Cigarette
products usually contain nicotine, which is addictive, raising concerns about e-cigarette use
and nicotine addiction in children. Exposure to nicotine during adolescence can harm the
developing brain, which may affect brain function and cognition, attention, and mood; thus,
minimizing nicotine exposure from any tobacco product in youth is important.

OBJECTIVE To update its 2013 recommendation, the USPSTF commissioned a review of the
evidence on the benefits and harms of primary care interventions for tobacco use prevention
and cessation in children and adolescents. The current systematic review newly included
e-cigarettes as a tobacco product.

POPULATION This recommendation applies to school-aged children and adolescents younger
than 18 years.

EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that primary
care–feasible behavioral interventions, including education or brief counseling, to prevent
tobacco use in school-aged children and adolescents have a moderate net benefit. The
USPSTF concludes that there is insufficient evidence to determine the balance of benefits
and harms of primary care interventions for tobacco cessation among school-aged children
and adolescents who already smoke, because of a lack of adequately powered studies on
behavioral cou